Azumi Motoi, Suda Takeshi, Terai Shuji, Akazawa Kouhei
Department of Medical Informatics, Graduate School of Medical and Dental Sciences, Japan.
Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan.
Intern Med. 2017;56(9):1001-1007. doi: 10.2169/internalmedicine.56.7278. Epub 2017 May 1.
Objective Radiofrequency ablation has been used widely for the local ablation of hepatocellular carcinoma, particularly in its early stages. The study aim was to identify significant prognostic factors and develop a predictive nomogram for patients with hepatocellular carcinoma who have undergone radiofrequency ablation. We also developed the formula to predict the probability of 3- and 5-year overall survival based on clinical variables. Methods We retrospectively studied 96 consecutive patients with hepatocellular carcinoma who had undergone radiofrequency ablation as a first-line treatment. Independent and significant factors affecting the overall survival were selected using a Cox proportional hazards model, and a prognostic nomogram was developed based on these factors. The predictive accuracy of the nomogram was determined by Harrell's concordance index and compared with the Cancer of the Liver Italian Program score and Japan Integrated Staging score. Results A multivariate analysis revealed that age, indocyanine green plasma disappearance rate, and log (des-gamma-carboxy prothrombin) level were independent and significant factors influencing the overall survival. The nomogram was based on these three factors. The mean concordance index of the nomogram was 0.74±0.08, which was significantly better than that of conventional staging systems using the Cancer of the Liver Italian Program score (0.54±0.03) and Japan Integrated Staging score (0.59±0.07). Conclusion This study suggested that the indocyanine green plasma disappearance rate and age at radiofrequency ablation (RFA) and des-gamma-carboxy-prothrombin (DCP) are good predictors of the prognosis in hepatocellular carcinoma patients after radiofrequency ablation. We successfully developed a nomogram using obtainable variables before treatment.
目的 射频消融已广泛用于肝细胞癌的局部消融，尤其是在其早期阶段。本研究旨在确定肝细胞癌患者接受射频消融后的显著预后因素，并建立预测列线图。我们还基于临床变量开发了预测3年和5年总生存率概率的公式。方法 我们回顾性研究了96例连续接受射频消融作为一线治疗的肝细胞癌患者。使用Cox比例风险模型选择影响总生存的独立且显著的因素，并基于这些因素建立预后列线图。通过Harrell一致性指数确定列线图的预测准确性，并与意大利肝癌计划评分和日本综合分期评分进行比较。结果 多因素分析显示，年龄、吲哚菁绿血浆消失率和log（去γ-羧基凝血酶原）水平是影响总生存的独立且显著的因素。列线图基于这三个因素。列线图的平均一致性指数为0.74±0.08，显著优于使用意大利肝癌计划评分（0.54±0.03）和日本综合分期评分（0.59±0.07）的传统分期系统。结论 本研究表明，吲哚菁绿血浆消失率、射频消融时的年龄和去γ-羧基凝血酶原是肝细胞癌患者射频消融后预后的良好预测指标。我们成功地使用治疗前可获得的变量开发了列线图。
